Revue francaise des maladies respiratoires最新文献

The concentration of major basic protein (MBP) of the eosinophilic granules in bronchial expectoration (Sputum) were measured by radioimmunoassay in 204 subjects suffering from various illnesses of both the respiratory tract and other systems. 31 of these subjects were later revealed to have asthma and all had very high sputum MBP levels. The MBP level was much greater in asthmatics than any other respiratory or non-respiratory ailment and in a statistically significant fashion (p less than 0.001). 25 other subjects who were in hospital for exacerbations of asthma were subsequently tested; their MBP concentrations were higher still. During the course of their hospital stay the sputum MBP levels fell significantly following treatment with steroids and broncho-dilators. The measurement of the MBP level would seem useful in those situations where the diagnosis of asthma is not evident from the history and may help in predicting the effectiveness of steroid treatment.

The technique of intracavitary aspiration introduced by Monaldi in 1938 in the treatment of tuberculous cavities and then applied by him in the treatment of lung abscesses was forgotten for nearly 30 years. The advent of antibiotics and their success explain its abandonment. It may take an important place again in the treatment of difficult cases, as a last resort, after failure of properly conducted classical medical treatment. A study of 20 hospitalised patients in an intensive care unit presenting with severe pulmonary abscesses demonstrates this point. After recalling the causes, the therapeutic difficulties and the complications of these abscesses, the authors describe the medications, the method of endocavitary drainage and the technical problems posed by its use in patients often artificially ventilated. The absence of any major dangers inherent in using this technique is also discussed. Finally the short (one month) and long term (20 months) results were analysed. Three deaths occurred during the initial period, although largely explained by associated lesions in these patients. The other 17 patients, of whom 11 were followed up for more than six months, had a satisfactory outcome from the respiratory stand-point. The disappearance of all signs of infection was constantly obtained and in only four patients the bullous cavities persisted. The authors conclude by attesting the efficacy of the technique and its low risk often in the most critically ill patients.

In order to assess the prognosis significance of the first episode of acute respiratory failure in chronic bronchitic, 100 bronchitics experiencing an episode of failure were followed for 3 1/2 to 6 years. A multivariate statistical analysis revealed the best prognostic parameters: the FEV1 (VEMS), the steady state Co transfer, age, neuro-psychiatric signs of respiratory failure and supra-ventricular dysrhythmias on ECG. Normocapnia contributes to a stabilised respiratory state. A predictive value could not be established for the clinical signs of right ventricular failure and of right ventricular hypertrophy on the ECG. Cardio-respiratory failure is the dominant cause of death but other causes occur more frequently in those subjects with severe respiratory impairment.

The natural history of sarcoidosis is favourable in 90% of cases; in 10% deterioration occurs with the appearance of respiratory failure, aspergillous or tuberculous infections which cause death in 5% of patients. Thus the problem for the clinician is the early detection and treatment of those patients whose outcome will be unfavourable. Certain clinical pointers exist measuring the activity and the dissemination of the sarcoidosis as well as its consequences. Among these are radiology, biological tests (such as the serum angiotensin converting enzyme of differential cell counts on bronchoalveolar lavage), scintigraphy and respiratory function; despite the above it is more difficult to determine the prognosis early as in practice this is decided by repetitive screening tests. Steroid therapy seems more effective than other treatments. But drugs cannot be held responsible for those cures which occur apparently unrelated to the treatment received; the occurrence of relapses after interruptions of treatment demand prolonged treatment if an unfavourable outcome is suspected.

The author reviews recent ideas on allergic occupational respiratory disorders which clearly define the severity and the possibility of a cure, thanks to early diagnosis. The diversity of specific and non-specific causes of occupational asthma and the need for research into new causes of pulmonary granulomas are emphasized. The basis for industrial compensation and medico-social prevention are recalled. The author finally looks to the future for a detailed epidemiological study in matters relating to allergic occupational respiratory diseases.

Hypoxaemia secondary to chronic bronchopulmonary disease may lead to total invalidity and be complicated by right heart failure. Consistent and meticulous medical care may produce a notable improvement by not smoking, using bronchodilators, mucolytics and physiotherapy. If, despite these measures, frank hypoxaemia persists, then domiciliary oxygen should be considered. The need for prolonged oxygen therapy of more than 15 hours is often countered by the scepticism and lack of discipline of the patient and family. In cases of hypoxaemia which are partially refractory or are associated with hypercapnia prolonged mechanical ventilation with a tracheotomy will ensure considerable salvage in those with severe restrictive defects and right heart failure. The supervision of oxygen therapy requires not only adequate control of blood gases, but also collaboration between the family doctor, the respiratory physician and home visitors such as the nurse or technician.

Five cases are reported of embryonal carcinoma with a vitelline structure more or less predominating. The presentation was of an anterior mediastinal tumour occurring in young men and in three cases there was mediastinal obstruction. The clinical examination, in particular testicular examination, was negative. In each case the level of the alpha-fetoprotein was greater than 1,000 micrograms/l, even post-operatively. The alpha-fetoprotein and HCG-beta should be measured systematically in all cases of anterior mediastinal tumour occurring in young subjects, and would enable a more frequent identification of tumours with difficult histology. The serum levels reflected the changes noted clinically and radiologically. Polychemotherapy bases around cis platinum led to a significant but transitory regression of the tumours. Radiotherapy was ineffective. Surgery was never totally curative.

Free oxygen radicals result from aerobic cellular metabolism; their toxicity is prevented by immediate degradation due to an endless variety of biochemical systems. The nature of these radicals, their cellular production as well as the defence mechanism which oppose their toxic effects are successively and briefly analysed. The potential role of these radicals in the genesis of different lung diseases is still poorly understood. However, certain toxic agents (oxygen, gas pollutants, ionising radiation, toxic products) can act as a whole or at least in part by their intermediaries. The experimental arguments in favour of this hypothesis are reviewed in passing. If the relative importance of the toxic mechanism is still imprecise, free radicals are certainly implicated in pulmonary disease and constitute a new aspect of respiratory patho-physiology.